QUALITY ASSESSMENT OF THE SURGERY CENTER REGARDING STRUCTURE, PROCESS AND RESULTS

Gomes, José Augusto; Martins, Maria Manuela; Tronchin, Daisy Maria Rizatto; Fernandes, Carla Sílvia

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ORIGINAL ARTICLE • Cogitare enferm. 26 • 2021 • https://doi.org/10.5380/ce.v26i0.71083 copy

QUALITY ASSESSMENT OF THE SURGERY CENTER REGARDING STRUCTURE, PROCESS AND RESULTS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to assess the quality of the surgery centers in Portuguese hospitals regarding structure, process and results.

Method:

a quantitative and cross-sectional study conducted between January and May 2018. The sample consisted in 1,019 professionals from 71 Portuguese hospitals. Three different instruments were used to assess quality in structure, process and results in the surgery center, namely: the Scale of Structure Indicators in the Operating Room, the Scale of Care Quality Processes in the Operating Room and the Scale to measure the Quality Results in the Operating Room.

Results:

the “specificities of the professional groups”, “communication flows”, “control for safety” and “teamwork” factors were considered as of high quality.

Conclusion:

the quality assessment of the surgery center in the structure, process and results categories allows identifying gaps that can be improved and require greater attention.

DESCRIPTORS:
Assessment in Health; Operating Rooms; Quality Management; Nursing; Quality Improvement

FACTORS	MIN_MAX	QUALITY LEVEL	VALUES
Environment and equipment	5-25	Low quality	5 to14
		Medium quality	15 to 19
		High quality	20 to 25
Resources for quality and safety	6-35	Low quality	7 to 20
		Medium quality	21 to 27
		High quality	28 to 35
Circuits in the operating room	4-20	Low quality	4 to 11
		Medium quality	12 to 15
		High quality	16 to 20
Facilities and operational requirements	6-30	Low quality	6 to 17
		Medium quality	18 to 23
		High quality	24 to 30
Training and praxis in the operating room	3-15	Low quality	3 to 8
		Medium quality	9 to 11
		High quality	12 to 15
Continuity in Nursing care and Specificities of the professional groups	2-10	Low quality	2 to 5
		Medium quality	6 to 7
		High quality	8 to 10
Specificities of the professional groups	1-5	Low quality	1 to 2
		Medium quality	3
		High quality	4 to 5

FACTORS	MIN_MAX	QUALITY LEVEL	VALUES
Communication flows	7-35	Low quality	7 to 20
		Medium quality	21 to 27
		High quality	28 to 35
Support strategies for the assistance work processes	6-30	Low quality	6 to 17
		Medium quality	18 to 23
		High quality	24 to 30
Control for safety	2-10	Low quality	2 to 5
		Medium quality	6 to 7
		High quality	8 to 10
Teamwork	2-10	Low quality	2 to 5
		Medium quality	6 to 7
		High quality	8 to 10

FACTORS	MIN_MAX	QUALITY LEVEL	VALUES
Assessment of care quality	6-30	Low quality	6 to 17
		Medium quality	18 to 23
		High quality	24 to 30
Assessment of the processes	4-20	Low quality	4 to 11
		Medium quality	12 to 15
		High quality	16 to 20
Control systems	3-15	Low quality	3 to 8
		Medium quality	9 to 11
		High quality	12 to 15

Factors	Descriptive measures
Factors	Min	Max	Median	Mode	Mean	SD^* *DP – Desvio Padrão	Quality level
Structure Dimension
Environment and equipment	5	25	19	20	17.9	4.7	Medium quality
Resources for quality and safety	8	35	26	28	25	5.6	Medium quality
Circuits in the operating room	4	20	12	4	11.6	4.8	Medium quality
Facilities and operational requirements	7	30	21	22	20.4	5.9	Medium quality
Training and praxis in the operating room	3	15	12	12	11.2	2.9	Medium quality
Continuity in Nursing care	2	10	2	2	4	2.7	Low quality
Specificities of the professional groups	1	5	4	4	3.9	1.1	High quality
Process Dimension
Communication flows	8	35	29	30	28	4.7	High quality
Support strategies for the assistance work processes	6	30	21	22	20	5.1	Medium quality
Control for safety	2	10	10	10	9	1.4	High quality
Teamwork	2	10	9	10	9	1.5	High quality
Results Dimension
Assessment of care quality	6	30	19	18	18.4	6.4	Medium quality
Assessment of the processes	4	20	12	12	12.0	4.1	Medium quality
Control systems	3	15	10	10	10.1	3.3	Medium quality

Dimensão Estrutura
Fatores	Valores da Escala		Tipo de centro cirúrgico
Fatores	Média	Desvío Padr ioo	Estat. teste	Valor-p
Environment and equipment
Central sector	17,8	4,7	32,5	< 0,001
Urgency sector	12,4	3,2
Outpatient sector	19,3	4,6
Orthopedics sector	21,3	3,8
Other sector	18,1	4,5
Resources for quality and safety
Central sector	24.8	5,5	36,1	< 0,001
Urgency sector	18,9	4,4
Outpatient sector	27,5	5,3
Orthopedics sector	29,4	4,7
Other sector	24,3	5,9
Circuits in the operating room
Central sector	11,5	4,7	23,1	< 0,001
Urgency sector	9,3	3,6
Outpatient sector	14	4,6
Orthopedics sector	14,4	4,3
Other sector	7,1	3,9
Facilities and operational requirements
Central sector	20,3	5,7	27,2	< 0,001
Urgency sector	13,6	4,3
Outpatient sector	22,5	5,2
Orthopedics sector	26	6,2
Other sector	16,4	6,7
Training and praxis in the operating room
Central sector	11,2	2,8	21,4	< 0,001
Urgency sector	6,9	3,1
Outpatient sector	11,8	2,5
Orthopedics sector	12,8	2,3
Other sector	9,8	2,9
Continuity in Nursing care
Central sector	3,9	3,6	22,1	< 0,001
Urgency sector	2,8	1,7
Outpatient sector	5,3	2,9
Orthopedics sector	5,4	2,9
Other sector	3,9	2,5
Specificities of the professional groups
Central sector	3,9	1,1	2,3	0,517
Urgency sector	4,2	0,8
Outpatient sector	3,8	1,1
Orthopedics sector	3,6	1,4
Other sector	3,9	1
Process Dimension
Communication flows
Central sector	28,8	4,6	12,3	0,007
Urgency sector	24,2	5,6
Outpatient sector	28,9	4,8
Orthopedics sector	31,5	3,5
Other sector	26,5	5,5
Support strategies for the assistance work processes
Central sector	20,3	5	24,5	< 0,001
Urgency sector	16,5	5,9
Outpatient sector	22,8	5
Orthopedics sector	24,3	5,1
Other sector	18,9	5,1
Control for safety
Central sector	9,3	1,4	4	0,258
Urgency sector	9,6	0,7
Outpatient sector	9,4	1,2
Orthopedics sector	8,8	1,7
Other sector	8,5	2,5
Teamwork
Central sector	8,6	1,5	4,7	0,196
Urgency sector	8,2	1
Outpatient sector	8,9	1,3
Orthopedics sector	8,6	1,9
Other sector	8,5	1,4
Results Dimension
Assessment of care quality
Central sector	18,3	6,4	24,7	< 0,001
Urgency sector	12,8	5,4
Outpatient sector	21,3	5
Orthopedics sector	23,2	6,4
Other sector	15,5	5,6
Assessment of the processes
Central sector	11,8	4	19,7	0,000
Urgency sector	9,6	3,8
Outpatient sector	13,8	3,9
Orthopedics sector	15	4,2
Other sector	9,9	3,4
Control systems
Central sector	9,9	3,2	31	< 0,001
Urgency sector	6,2	2,8
Outpatient sector	11,5	3,2
Orthopedics sector	12	3,3
Other sector	9,1	3,1

Dimensão Estrutura
Factors	Values of the Scale		By Region
Factors	Mean	Standard Deviation	Stat. test	p-value
Environment and equipment			46,1	< 0,001
North	17,9	4,7
Central	17,4	4,6
Lisboa Vale do Tejo	17,9	4,9
Alentejo	20,5	3,1
Algarve	13,4	5,9
Madeira	20,3	0,6
Açores	14,5	4,7
Resources for quality and safety			32,5	< 0,001
North	25,7	5,6
Central	23,8	5,3
Lisboa Vale do Tejo	24,9	5,7
Alentejo	24,4	4,2
Algarve	18,6	7,3
Madeira	26	3,6
Açores	25,1	3,9
Circuits in the operating room			36,1	< 0,001
North	11,6	4,9
Central	12,3	4,4
Lisboa Vale do Tejo	11,4	4,9
Alentejo	8,4	3,5
Algarve	7,9	4
Madeira	13	3,6
Açores	13,2	3,2
Facilities and operational requirements			35,1	< 0,001
North	20,8	6
Central	19,5	5,3
Lisboa Vale do Tejo	19,8	6,1
Alentejo	23,5	4,5
Algarve	14	7
Madeira	19,6	4,9
Açores	20,7	4,9
Training and praxis in the operating room			13,6	0,035
North	11	2,9
Central	11,1	2,8
Lisboa Vale do Tejo	11,5	2,8
Alentejo	11,4	2,5
Algarve	8,7	3,5
Madeira	9,7	2,5
Açores	10,9	2,9
Continuity in Nursing care			16,2	0,013
North	4,2	2,8
Central	3,9	2,6
Lisboa Vale do Tejo	4,1	2,7
Alentejo	2,7	1,5
Algarve	3,6	2,6
Madeira	6	3,4
Açores	3,4	1,8
Specificities of the professional groups			12,2	0,059
North	3,8	1,2
Central	3,9	1,1
Lisboa Vale do Tejo	4,1	0,9
Alentejo	3,8	1,2
Algarve	4,3	0,7
Madeira	4,3	0,6
Açores	3,6	1,3
Process Dimension
Communication flows			17,3	0,008
North	28,6	4,6
Central	27,9	4,5
Lisboa Vale do Tejo	27,7	4,9
Alentejo	28,8	3,4
Algarve	25,3	7,6
Madeira	29	1
Açores	27	4,2
Support strategies for the assistance work processes			19,7	0,003
North	20,8	5,3
Central	19,9	4,7
Lisboa Vale do Tejo	20,6	5,3
Alentejo	19,9	4,6
Algarve	17,5	5,6
Madeira	22,3	1,5
Açores	16,6	6,1
Control for safety			22,1	0,001
North	9,1	1,5
Central	9,4	1,2
Lisboa Vale do Tejo	9,2	1,7
Alentejo	9,7	0,8
Algarve	10	0
Madeira	10	0
Açores	8,9	1,7
Teamwork			7,6	0,273
North	8,6	1,6
Central	8,5	1,6
Lisboa Vale do Tejo	8,7	1,3
Alentejo	8,5	1,4
Algarve	8,5	1,2
Madeira	9,7	0,6
Açores	9	1,9
Results Dimension
Assessment of care quality			42	< 0,001
North	19,2	6,4
Central	17,9	6,3
Lisboa Vale do Tejo	17,5	6,3
Alentejo	17,1	5,8
Algarve	15,3	6,2
Madeira	21,7	2,5
Açores	12,2	5,5
Assessment of the processes			37,2	< 0,001
North	12,6	4,1
Central	11,3	3,9
Lisboa Vale do Tejo	11,4	4,2
Alentejo	11,9	3,4
Algarve	9,5	4,2
Madeira	15,3	3
Açores	8,7	4,3
Control systems			38,7	< 0,001
North	10,3	3,3
Central	9,7	3,2
Lisboa Vale do Tejo	10,3	3,3
Alentejo	8,5	3,1
Algarve	7,5	2,1
Madeira	9	4,4
Açores	8,8	3,7

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[1] Corresponding author: Carla Silvia Fernandes Escola Superior de Enfermagem do Porto - Porto, Portugal E-mail: carlasilviaf@gmail.com